Coconut Model for Learning First Steps of Craniotomy Techniques and Cerebrospinal Fluid Leak Avoidance

Endoscopic Suturing of Skull Base Dura and its Effectiveness in Preventing CSF Leak

Proper skull base repair is essential in preventing postoperative cerebrospinal fluid (CSF) leak following endonasal endoscopic skull base surgery. Direct suturing of the skull base dura is desirable but difficult. Here, we discuss the effectiveness of endoscopic suturing of skull base dura in cases of skull base lesions with intraoperative CSF leak. A total of 36 cases (three arachnoid cyst, two Rathke's cleft cyst, two tuberculum sella meningioma, and 29 pituitary adenoma) where dura was sutured endoscopically after endonasal endoscopic excision of lesion were evaluated. Endoscopic suturing was categorized in to three types (type 1 - dura with tumor excised and single suture placed across the anterior tuberculum sella dura to clival dura, type 2 - dura excised partially and repaired with multiple interrupted sutures, type 3 - dura was completely intact at the end of surgery and closed with interrupted suture). Type 1 dura closure was performed in eight cases, type 2 in 16 cases, and type 3 in 12 cases. Two patients with type 1 closure had CSF leak in the postoperative period and managed with lumbar puncture. None of the other patients had CSF leak after surgery. Direct suturing of the skull base dura is effective in preventing postoperative CSF leak. Even a single suture is able to hold the fat graft in place and provides sufficient support against pulsatile CSF flow and thereby reduces the incidence of postoperative CSF leak.

Neurosurgical skills conference for medical students: A before and after study

Background

Undergraduate conferences may improve exposure to neurosurgery among medical students. Hence, this study aimed to evaluate the effect of a neurosurgical skills conference on medical students' comprehension and perceptions of the specialty.

Methods

A before-and-after (BA) study design was employed to assess the effects of a conference that integrated presentations with hands-on sessions. Practical workshops covered craniotomy, spinal fixation, surface anatomy, intracranial pressure (ICP) monitoring, basic surgical skills, and microsurgical simulation. Pre-conference and post-conference surveys, utilizing Likert scales, gauged participants' attitudes, prior neurosurgical exposure, and understanding of neurosurgical skills. Statistical analysis was conducted on dichotomized responses.

Results

Thirty-one participants completed both surveys, with the majority being 1st and 2nd-year medical students. Among the participants, 58.1% were female, and 77.4% identified with BAME ethnicities. Following the conference, there was a notable increase in comprehension regarding neurosurgical careers (from 58.1% to 96.8%, P < 0.001) and training criteria (from 22.6% to 93.5%, P < 0.001). The conference enhanced knowledge of indications for craniotomy (P < 0.001), ICP monitoring (P < 0.001), and spinal fixation (P < 0.001). Participants reported improved understanding of the steps involved in craniotomy (P < 0.001), familiarity with basic cranial surgical surface anatomy (P < 0.001), and confidence in performing basic surgical instrument ties (P < 0.001). Although interest in pursuing a career in neurosurgery remained high (from 87.1% to 90.3%, P = 1.000), a majority of participants, both BA the conference, expressed concerns about the impact on personal life (from 58.1% to 64.5%, P = 0.774).

Conclusion

This study underscores the role of undergraduate mixed-method conferences in augmenting understanding of neurosurgery and nurturing early interest.

Dundee Annual Neurosurgery Skills Event (DANSE)-Improving the Availability and Affordability of Neurosurgical Skills Workshops for Medical Students

Background  Neurosurgery can be a daunting career choice for medical students, with preparation for trainee application often being inaccessible and expensive. This article describes a student-led neurosurgical skills event supported by local neurosurgery faculty members. Such event was designed to offer a means to bridge this gap by providing an opportunity to practice neurosurgical techniques in simulation, and learn about what a career in neurosurgery involves. Methods  Pre- and postskills laboratory surveys were used to ascertain the baseline confidence and knowledge of common neurosurgical techniques, as well as to what both the application to neurosurgery and the typical workload of a neurosurgeon involves. The conference offered six neurosurgical workshops as well as three lectures to provide practical and theoretical learning opportunities. The session included introduction to the candidates and faculty, identification of learning objectives, and career discussion. Postcourse feedback also was also used to assess learning outcomes. Results  Eighteen students attended the event. Postskills event, students were significantly more likely to understand the principles behind all of the relevant neurosurgical skills included on the day. Additionally, students were more likely to understand what a career in neurosurgery involves, and how to approach applying for a training number. Respondents enjoyed the workshops, valued hands-on experience and interactions with consultants, found it affordable, and would recommend to their peers. Conclusions  For medical students interested in a career in neurosurgery, opportunities to learn relevant techniques and skills are often expensive and difficult to come across. Here, we highlight affordable methods of simulation to result in significant student satisfaction. Additionally, providing ample opportunity to practice different neurosurgical techniques under almost 1:1 level tutoring enables significant increases in students' confidence and understanding of different neurosurgical concepts. We greatly encourage other medical student groups to develop their own hands-on simulation events to attract medical students to a surgical field often considered daunting and inaccessible, and address gaps in the medical school curriculum.

Neurosurgical simulation models developed in Latin America and the Caribbean: a scoping review

Simulation training is an educational tool that provides technical and cognitive proficiency in a risk-free environment. Several models have recently been presented in Latin America and the Caribbean (LAC). However, many of them were presented in non-indexed literature and not included in international reviews. This scoping review aims to describe the simulation models developed in LAC for neurosurgery training. Specifically, it focuses on assessing the models developed in LAC, the simulated neurosurgical procedures, the model's manufacturing costs, and the translational outcomes. Simulation models developed in LAC were considered, with no language or time restriction. Cadaveric, ex vivo, animal, synthetic, and virtual/augmented reality models were included for cranial and spinal procedures. We conducted a review according to the PRISMA-ScR, including international and regional reports from indexed and non-indexed literature. Two independent reviewers screened articles. Conflicts were resolved by a third reviewer using Covidence software. We collected data regarding the country of origin, recreated procedure, type of model, model validity, and manufacturing costs. Upon screening 917 studies, 69 models were developed in LAC. Most of them were developed in Brazil (49.28%). The most common procedures were related to general neurosurgery (20.29%), spine (17.39%), and ventricular neuroendoscopy and cerebrovascular (15.94% both). Synthetic models were the most frequent ones (38.98%). The manufacturing cost ranged from 4.00 to 2005.00 US Dollars. To our knowledge, this is the first scoping review about simulation models in LAC, setting the basis for future research studies. It depicts an increasing number of simulation models in the region, allowing a wide range of neurosurgical training in a resource-limited setting.

Mixed Reality as a Teaching Tool for Medical Students in Neurosurgery

Background and Objectives: Simulation-based learning within neurosurgery provides valuable and realistic educational experiences in a safe environment, enhancing the current teaching model. Mixed reality (MR) simulation can deliver a highly immersive experience through head-mounted displays and has become one of the most promising teaching tools in medical education. We aimed to identify whether an MR neurosurgical simulation module within the setting of an undergraduate neurosurgical hands-on course could improve the satisfaction of medical students. Materials and Methods: The quasi-experimental study with 223 medical students [120 in the conventional group (CG) and 103 in the MR-group (MRG)] was conducted at the University Hospital Münster, Münster, Germany. An MR simulation module was presented to the intervention group during an undergraduate neurosurgical hands-on course. Images of a skull fracture were reconstructed into 3D formats compatible with the MR-Viewer (Brainlab, Munich, Germany). Participants could interact virtually with the model and plan a surgical strategy using Magic Leap goggles. The experience was assessed by rating the course on a visual analog scale ranging from 1 (very poor) to 100 (very good) and an additional Likert-scale questionnaire. Results: The satisfaction score for CG and MRG were 89.3 ± 13.3 and 94.2 ± 7.5, respectively. The Wilcoxon rank-sum test showed that MR users (Mdn = 97.0, IQR = 4, n = 103) were significantly more satisfied than CG users (Mdn = 93.0, IQR = 10, n = 120; ln(W) = 8.99, p < 0.001) with moderate effect size (r^biserial = 0.30, CI95 [0.15, 0.43]), thus indicating that the utilization of MR-simulation is associated with greater satisfaction. Conclusions: This study reports a positive response from medical students towards MR as an educational tool. Feedback from the medical students encourages the adoption of disruptive technologies into medical school curricula.